How to examine anastomotic integrity intraoperatively in totally laparoscopic radical gastrectomy? Methylene blue testing prevents technical defect-related anastomotic leaks

doi:10.4240/wjgs.v14.i4.315

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World Journal of Gastrointestinal Surgery

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World J Gastrointest Surg. Apr 27, 2022; 14(4): 315-328
Published online Apr 27, 2022. doi: 10.4240/wjgs.v14.i4.315

How to examine anastomotic integrity intraoperatively in totally laparoscopic radical gastrectomy? Methylene blue testing prevents technical defect-related anastomotic leaks

Chun Deng, Yang Liu, Zhen-Yu Zhang, Heng-Duo Qi, Zhi Guo, Xu Zhao, Xiao-Jun Li

Chun Deng, Yang Liu, Zhen-Yu Zhang, Heng-Duo Qi, Zhi Guo, Xu Zhao, Xiao-Jun Li, Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi Province, China

Author contributions: Deng C designed and performed the research and wrote the paper; Liu Y, Zhang ZY, and Qi HD designed the research and supervised the report; Guo Z and Zhao X provided clinical advice; Li XJ designed and performed the research and supervised the report.

Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Shaanxi Provincial People's Hospital.

Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.

Conflict-of-interest statement: We have no financial relationships to disclose.

Data sharing statement: No additional data are available.

Corresponding author: Xiao-Jun Li, MD, Professor, Surgeon, Department of General Surgery, Shaanxi Provincial People's Hospital, No. 256 Youyi West Road, Xi'an 710068, Shaanxi Province, China. lixiaojun20040912@163.com

Received: November 11, 2021
Peer-review started: November 11, 2021
First decision: January 9, 2022
Revised: January 20, 2022
Accepted: April 4, 2022
Article in press: April 4, 2022
Published online: April 27, 2022
Processing time: 164 Days and 4.7 Hours

ARTICLE HIGHLIGHTS

Research background

We hypothesized that intraoperative methylene blue testing (IMBT) could reduce the incidence of postoperative anastomotic leaks (PALs) in totally laparoscopic radical gastrectomy.

Research motivation

IMBT, air leak testing, or endoscopy is used to assess the anastomotic integrity of esophagojejunostomy during open total gastrectomy for gastric cancer. To the best of our konwledge, this is the first study to assess the anastomotic integrity during totally laparoscopic radical gastrectomy.

Research objectives

To explore the effects of IMBT on the incidence of PALs and identify the risk factors for PALs in totally laparoscopic radical gastrectomy.

Research methods

The difference in the incidence of PALs was compared between the IMBT group and the control group. Logistic regression analysis was used to clarify the risk factor for positive IMBT and PALs.

Research results

Positive IMBT was shown in 7 patients (3.3%) in the IMBT group, and no PAL occurred in these patients after suture reinforcement. Moreover, 15 patients (2.9%) developed PALs, and the rate of PALs was significantly lower in the IMBT group than in the control group [2 of 211 patients (0.9%) vs 13 of 302 patients (4.3%), P = 0.0026]. Further analysis demonstrated that preoperative complications (hazard ratio [HR] = 13.128, P = 0.017), totally laparoscopic total gastrectomy (HR = 9.075, P = 0.043), and neoadjuvant chemotherapy (HR = 7.150, P = 0.008) were independent risk factors for PALs.

Research conclusions

IMBT can find technical defects within an anastomosis, and suturing can reduce the incidence of PALs in totally laparoscopic radical gastrectomy. Independent risk factors associated with PAL include preoperative complications, totally laparoscopic total gastrectomy, and neoadjuvant chemotherapy.

Research perspectives

Randomized controlled trials are expected to be conducted to measure the effects of IMBT.